Kitajima Yoko, Maruyama-Inoue Maiko, Ito Arisa, Sato Shimpei, Inoue Tatsuya, Yamane Shin, Kadonosono Kazuaki
Department of Ophthalmology, Kanto Rosai Hospital, Kawasaki, Japan.
Department of Ophthalmology & Micro-technology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Graefes Arch Clin Exp Ophthalmol. 2020 Jun;258(6):1279-1285. doi: 10.1007/s00417-020-04661-4. Epub 2020 Mar 31.
To identify the functional outcome and evaluate the morphologic changes of patients with pachychoroid neovasculopathy (PNV) undergoing intravitreal anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) at the 1-year follow-up.
We retrospectively studied all the treatment-naïve PNV patients who were scheduled to undergo combination therapy between September 2017 and November 2018. All the patients received three consecutive monthly injections of 0.5 mg/0.05 mL ranibizumab as loading doses. Full-dose PDT was performed within 1 week of the first injection. Retreatment was allowed if evidence of clinical deterioration or the presence of fluid on spectral-domain optical coherence tomography examination performed at the 1-month follow-up was noted. The best-corrected visual acuity (BCVA) was compared before treatment and at 3, 6, and 12 months after the initial treatment. Changes in the central foveal thickness (CFT), central choroidal thickness (CCT), and retreatment rate during the maintenance phase were also evaluated.
Eleven eyes were enrolled in this study. Significantly, better BCVA was observed at 12 months than at baseline (P = 0.010). The mean CFT significantly decreased from 331 ± 93 to 237 ± 72 μm at 12 months (P < 0.001). The mean CCT also significantly decreased from 361 ± 74 to 310 ± 83 μm at 12 months (P < 0.001). The mean number of injections per eye was 3.9 ± 1.3 during the follow-up period. A total of 45.5% (5 /11) of the patients required retreatment during the maintenance phase.
Anti-VEGF combined with full-dose PDT was well tolerated and appeared to be effective treatment for patients with treatment-naïve PNV. Combination therapy might also reduce the treatment burden with fewer injections in patients with PNV.
确定接受玻璃体内抗血管内皮生长因子（VEGF）联合光动力疗法（PDT）治疗的肥厚性脉络膜新生血管病（PNV）患者在1年随访时的功能转归并评估其形态学变化。
我们回顾性研究了2017年9月至2018年11月期间计划接受联合治疗的所有初治PNV患者。所有患者均连续3个月每月注射0.5mg/0.05mL雷珠单抗作为负荷剂量。在首次注射后1周内进行全剂量PDT。如果在1个月随访时进行的光谱域光学相干断层扫描检查发现临床恶化或存在液体，则允许再次治疗。比较治疗前及初始治疗后3、6和12个月时的最佳矫正视力（BCVA）。还评估了维持期中央凹厚度（CFT）、中央脉络膜厚度（CCT）的变化以及再次治疗率。
本研究共纳入11只眼。显著地，12个月时的BCVA较基线时更好（P = 0.010）。12个月时，平均CFT从331±93μm显著降至237±72μm（P < 0.001）。12个月时，平均CCT也从361±74μm显著降至310±83μm（P < 0.001）。随访期间每只眼的平均注射次数为3.9±1.3次。共有45.5%（5/11）的患者在维持期需要再次治疗。
抗VEGF联合全剂量PDT耐受性良好，似乎是初治PNV患者有效的治疗方法。联合治疗还可能减轻PNV患者的治疗负担，减少注射次数。
